“Residence Premises” and Other Killer Exclusions, Part One

A few years ago, an order denying a summary judgment led to a spike in questions about the residency requirements found in the vast majority of standard homeowners forms. ^[1]

Those questions all centered on a particular piece of policy language which acts as a killer exclusion causing a hidden insurance coverage gap – one that’s been a topic of great controversy in the insurance industry for well over a decade. The topic dates back to an article published in an agents’ education journal twenty years ago about the distinction between “where you reside” and the “residence premises” wording found in homeowners insurance policies.

What Do “Residence Premises” Mean in the Context of Insurance Coverage?

In the world of homeowners insurance, the “residence premises” play a crucial role in defining what’s covered and what’s not. It essentially refers to the dwelling and surrounding property where you, as the named insured, actually reside. This typically includes a single-family home, or a specific unit within a multi-family dwelling where you live. Additionally, attached structures like garages and sheds fall under this umbrella.

However, the key term here is “reside.” The policy generally only covers losses happening at the location you truly inhabit as your primary residence. As we shall see, renting out the entire property or moving out for an extended period can potentially trigger exclusions, leaving you without coverage during that time. It’s important to understand this interplay between “residence premises” and “where you reside” to ensure your homeowner’s insurance effectively protects your property.

What Does “Where You Reside” Mean for Insurance Coverage?

When it comes to homeowners insurance, “Where You Reside” isn’t always as straightforward as it seems. The basic definition centers on the location where you, as the named insured, spend your daily life and maintain your permanent dwelling. This typically means the single-family home or specific unit within a multi-family building where you regularly sleep, eat, and conduct your day-to-day activities.

However, things get trickier when considering temporary absences or changes in living arrangements. Understanding these nuances is crucial in ensuring your homeowners insurance aligns with your actual living situation and provides the intended protection. The upcoming sections delve deeper into how courts interpret this complex concept and apply it to various scenarios, offering valuable insights into potential coverage limitations.

How Can the “Where You Reside” Clause Lead to Exclusions and Coverage Gaps?

The Independent Insurance Agents and Brokers of America, known as the Big I, is a fantastic resource for insurance agents. In 2009, eight years after the article published in the agents’ education journal, Bill Wilson, the author of When Words Collide: Resolving Insurance Coverage and Claims Disputes, wrote a Big I white paper on this topic: ‘Where You Reside’ – The ‘Where’s Waldo?’ Catastrophic Homeowners Policy ‘Exclusion’ That Could Bankrupt Your Insureds. His abstract describes the issue:

“The term ‘residence premises’ is defined to include the dwelling ‘where you reside.’ According to some interpretations and court decisions, if the named insured and/or resident spouse no longer reside in the dwelling, coverage on that structure immediately terminates. If this school of thought is correct, this gives rise to a number of circumstances that may lead to a catastrophic coverage gap for such insureds.”

Wilson noted 16 different common situations where “nonresidency” can arise:

Nursing Homes
Relocations
Foreclosures
Rentals
Child Occupies Parents’ Home
Parent Occupies Child’s Home
Divorce
Illness or Infirmary of Insured
Death of Insured
Trusts
Homes Owned by LLCs and Corporations
Seller Remains After Closing
Seller Moves Out Before Closing
Buyer Moves In or Takes Possession Before Closing
Renovations / Homes Under Construction
Vacancy and/or Unoccupancy

“Where You Reside” and Case Law

But how did the interpretation of this clause actually impact coverage in real instances? And was it applied in a consistent way? In fact, Wilson’s 2009 census of cases lists 18 cases with an exact 50/50 split of coverage decisions:

NO COVERAGE

Bryan v. United States Fire Ins. Co. (Texas, 1970)
Fisher v. Indiana Lumbermens Mutual Ins. Co. (Texas, 1972)
Doyle v. Members Mutual Ins. Co. (Texas, 1984)
Epps v. Nicholson (Georgia, 1988)
Shepard v. Keystone (Maryland 1990)
Nancarrow v. Aetna Casualty & Surety Co. (Arkansas, 1991)
Georgia Farm Bureau Mutual Ins. Co. v. Kephart (Georgia, 1993)
Heniser v. Frankenmuth Mutual Ins. Co. (Michigan, 1995)
Ivanov v. Phenix Mutual Ins. Co. (Maine, 2007)

COVERAGE

O’Neil v. Buffalo Fire Ins. Co. (New York, 1849)
Joyce v. Maine Ins. Co. (Maine, 1858)
German Ins. Co. v. Russell (Kansas, 1902)
Reid v. Hardware Mutual Ins. Co. (South Carolina, 1969)
Insurance Co. of North America v. Howard (Oregon, 1982)
Farmers Ins. Co. v. Trutanick (Oregon, 1993)
FBS Mortgage Corporation v. State Farm (Illinois, 1993)
Hill v. Nationwide Mutual Fire Ins. Co. (Georgia, 1994)
Lundquist v. Allstate Ins. Co. (Illinois, 2000)

Wilson argues for coverage and provides the following for his basis:

“Where you reside” are words of description, not a warranty of continuing occupancy.
The “where you reside” language is not clear and conspicuous.
Insureds have a reasonable expectation of coverage given the limited exclusions that apply to Coverage A and the implications of other policy provisions.
Owner-occupancy is an eligibility issue, not a coverage issue.
ISO programs have precedents that supersede the ownership-occupancy/residency requirement.
Any perceived increase in risk of loss is immaterial or inconsequential compared to the potential for catastrophic loss.
It is onerous, unconscionable, and against public policy to exclude all losses to a dwelling on the basis that there is a minor increase in risk for some perils.

“Residence Premises” Controversy Continues

In a 2015 Big I article, ISO Files Most Important Homeowners Change in 40 Years, Bill Wilson updated the status of the controversy and again argued against the exclusionary impact of the “where you reside” language:

For the record, OUR interpretation does not agree with that of a number of adjusters and courts. Numerous courts have held that, to be enforceable, an ‘exclusion’ must be ‘clear and conspicuous.’ We believe that coverage for the primary asset owned by a family should not hinge on three words in a definition referenced from an insuring agreement. There is nothing ‘clear and conspicuous’ about this language that would lead an insured to believe that an interruption of residency would suspend coverage on the dwelling. From the standpoint of public policy, it makes little sense that, if the insured is operating a meth lab and blows up his home, there is coverage under his HO policy, while there is no coverage for a tornado destroying her home the Friday evening an 80-year-old homeowner learns that she will be confined to a nursing home henceforth.

Courts that have found FOR coverage have generally interpreted the ‘where you reside’ language to be ‘words of description,’ not a warranty of occupancy or a condition for coverage. Additional rationales for our continued position on this are outlined in our original white paper. And, for what it’s worth, in a past Property Loss Research Bureau publication, PLRB also took the position that this language does not preclude coverage for damage to a dwelling.”

While he noted that optional endorsements would be placed in the marketplace removing the “where you reside” language from the definition of “residence premises,” he warned of continued problems and what leaders in the insurance agent community planned to do to stop these scenarios from happening in the future. ^[2]

“Residence Premises” in Case Law

We’ve also shared stories on our own blog about how “residence premise” has been interpreted by the courts. In What Constitutes a “Residence Premises?”, we highlighted a finding that a policyholder could have two residences and granted coverage. In No Coverage for Property that was not Insured’s “Primary Residence” as Described Under the Policy, we analyzed a Maryland case where the court ruled that no coverage existed to an insured for a loss to her property that was not her primary residence.

Another post, Does a Residence Restriction Violate the Standard Fire Insurance Policy?, summarized the court’s holding on a case in which the homeowner sued their insurance company, arguing a restriction requiring them to live in the property violated the standard insurance policy in their state. The court sided with the homeowner, rejecting the insurer’s claim that the restriction was similar to existing limitations on unoccupied or hazardous properties. The court found the residence restriction went further in limiting coverage than the standard provisions:

“First, the vacancy provision did not apply because the son lived in the insured premises at the time of the fire. Second, even if the vacancy provision applied, there was no substantial equivalence between the vacancy provision in the Iowa standard form and the residence restriction in the Auto-Owners policy; the vacancy provision precluded coverage only if the insured dwelling remained vacant for over sixty days, whereas the residence restriction could preclude coverage even when the property was not vacant or if it was vacant for less than sixty days. Finally, Auto-Owners failed to provide sufficient evidence indicating how a close family member occupying the insured dwelling increased the hazard or the risk of a fire loss. Because it limited coverage more so than the Iowa standard form, including its exclusion provisions, the residence restriction in the Auto-Owners policy impermissibly broadened the standard form’s exclusions and provided less coverage than the minimum required by statute. Coverage was therefore afforded for the fire loss.”

“Where You Reside” and Jury Trials

In 2020, Dan Ballard wrote a post, Question of Residency Is Determined by Jury. He noted the factors which the court found which would be considered by the jury on a case about “where you reside” may go to trial:

“The court also weighed other factors that supported residency, such as the insured receiving mail at the property address, providing the property address for income tax purposes, being the only person with keys to the property, and consistently referring to the property as ‘my house’ when testifying.

Stating that the term ‘residence’ carries a more transitory meaning than the term ‘domicile,’ the trial court ultimately concluded that the evidence on the record was sufficient to allow a reasonable jury to conclude that the insured resided at the property at the time of the fire.”

Part Two of this discussion will be about the Lamonica case, noted above. Coincidentally, the insurance defense attorney for Hartford in that matter is none other than the attorney William D. Wilson, whom I favorably blogged about in Great American Agrees to Pay Champlain Towers South Property Insurance Claim and More to Be Discussed on Tuesday @2 with Chip Merlin.

Further Resources on Insurance Coverage Law

Navigating the complexities of insurance claims can feel overwhelming. Whether you’re facing unpaid claims or simply filing for the first time, our eBooks equip you with the crucial information you need to advocate for yourself with confidence.

Why Merlin?

Are you struggling with an insurance company that won’t pay out on claims? With over 39 years of practice and $2 billion in recovered claims, our team will stand by your side to ensure you can face any insurance challenge with confidence. Contact us today for a consultation, or read more about how we’ll be your trusted advocate.

Thought For The Day

My main residence is Baltimore. I have an apartment in New York, one in San Francisco, and I live in a rental in Provincetown in the summer.
—John Waters, filmmaker
_______________________________________

¹ Lamonica v. Hartford Ins. Co. of the Midwest, No., 5:19cv78 (N.D. Fla. June 15, 2021).

² The full quote from Wilson:

“As indicated earlier, this resolution is not perfect or exactly what we believe is in the best interest of consumers, agents, and the industry at large. However, it is a reasonable compromise that we believe can serve as a starting point for a more complete market-based solution in the coming year. Still, there are caveats to this change that must be acknowledged.

First, even with a mandatory endorsement, there is still a potential for a coverage gap at policy inception for carriers who interpret the ‘where you reside’ language to be a residency requirement for coverage. For example, on new business it is customary to provide a policy (or, more likely, a binder) effective on the date of the loan closing. However, as is often the case, the insured may not move into the home and begin residency on the date of closing. As a result, for carriers with a restrictive interpretation of ‘where you reside,’ a Broadened endorsement should likely be used at policy inception and the insured made to understand the importance of revising the termination date on the form if move-in takes longer than expected.

Second, since renewals are usually processed a month or two in advance, even with a notice form, it’s possible that an insured might unexpectedly discontinue residency (e.g., medical conditions, unanticipated work relocation, military deployment, etc.) between completing the renewal paperwork and renewal policy inception. Again, it is critical when placing or renewing insureds with carriers that hold to a restrictive interpretation of ‘where you reside’ that the insured fully understand the importance of providing notice of nonresidency. In such instances, then Broadened endorsement may be used until (if necessary), the account needs to move from a Homeowners to a Dwelling Fire policy.

Third, when we originally presented this issue to ISO for consideration, one of the points we made with regard to our belief that this is an eligibility, not a coverage, issue is that ISO’s own eligibility rules permit the use of an HO policy on a home under construction. Obviously, no one can reside in a home under construction, so our argument is that a literal reading of the ‘where you reside’ language couldn’t preclude coverage because every unoccupied home under construction would have illusory coverage, something courts have uniformly found to be prohibitive. But, for insurers who hold the restrictive interpretation of ‘where you reside,’ the Broadened endorsement should be attached at inception for the duration of construction.”

…

“In the months prior to October 1, we will be approaching ACORD about the need to amend any existing ACORD forms and develop an industry-standard residency ‘notice’ form.

We will be issuing a news release on this change in the near future and making contact with various industry and consumer media. We recommend that agents do the same in their local communities and communicate this change to their customers.

We plan to initiate a dialog with independent agency carriers about adopting the Broadened language that eliminates the ‘where you reside’ language. We continue to believe that the restrictive interpretation of this language is detrimental to consumers and to the image of the insurance industry, and we believe that residency has always been, and should continue to be, an eligibility and underwriting consideration for new and renewal business, not an unclear and inconspicuous ‘exclusion.’”